Rental Assistance Application

Thank you for providing us the opportunity to assist you. We will review all requests, and you will receive an email when a decision is made. This normally takes 7 to 10 days. Please be aware it could take longer due to unforeseen circumstances.

Rental Assistance Guidelines/Requirements:

  • You must provide your home address.
  • You must explain why there is a need for assistance.
  • You must inform us of how much the total monthly rental payment is and the due date.
  • We do not assist with late fees or deposits.
  • We do not pay rental in full or in “advance”.
  • We do not make checks payable to an individual. If you are not renting from a property management company we will be unable to assist you.
  • An individual may only apply for assistance once per year.

If all information requested is not provided, we will be unable to process your request.

The need for assistance will be verified with the Property Manager and/or other source/organization involved.

Please note that we are unable to make checks payable to or mail to an individual. Please be sure to list the name and address of the rental company that will be able to accept the donation on your/their behalf.
By checking the box below, you agree you have read and accept the guidelines/requirements for receiving assistance.(Required)

Rental Assistance Application Form

Name(Required)







Address(Required)


















Date of Birth(Required)



Employed?(Required)


Marial status(Required)




If married, is spouse employed?


Head of Household?(Required)


We DO NOT make checks payable to individuals.
Address of Rental Company(Required)















Due Date(Required)



Is any of this amount past due?(Required)


Have you been assisted by The Long-Lewis Foundation in the past?(Required)


If so, when?



Have you received assistance from another organization/church in the past?


If so, when?